Persistent musculoskeletal presentations post-chikungunya fever: a case series in a state in northeast Brazil
DOI:
https://doi.org/10.33448/rsd-v11i3.26915Keywords:
Arbovirosis; Arthralgia; Chikungunya fever.Abstract
Chikungunya fever (CF) is an arbovirosis caused by the Chikungunya virus (CHIKV). The main characteristic of CF is joint pain and more than half of infected patients experience chronic conditions. This case series study evaluated the persistent musculoskeletal presentations of CF in a sample of 72 patients with persistent symptoms (≥1 month) after CF confirmed by laboratory tests (detection of CHIKV by polymerase chain reaction [PCR] and/or immunoglobulin [Ig]M and/or IgG). The patients were followed up for 12 months after treatment at the outpatient clinic of the University Hospital of the Federal University of Sergipe (Hospital Universitário da Universidade Federal de Sergipe - HU/UFS). They were evaluated at admission and after 1 month, 2 months, and then every 3 months for up to 12 months. Painful and/or swollen joints, periarticular symptoms, other important findings on physical examination, and visual analogue pain scale (VAS) were evaluated during all consultations. Main results: Among the patients evaluated, 84.7% were female, the mean age was 53.8 years, and the mean duration of musculoskeletal complaints was 6 months. Comorbidities were present in 61.1% of patients and previous musculoskeletal disease was present in 69.4%. The most frequent presentation on admission was polyarticular, which occurred in 76.4% of cases. The most affected joints were the hands, knees, ankles, and feet. VAS on admission was intense in 66.7% of patients. Tenosynovitis was present in 44.5% of patients and was more frequently reported in the ankles. Corticosteroids and chloroquine were administered to 65.3% and 31.98% of patients, respectively. The findings indicated that persistent musculoskeletal presentations occur frequently after CF. These results provide a better understanding of patient profiles, musculoskeletal involvement, and CF progression, and may guide effective strategies for therapeutic management.
References
Amaral, J. K., Bilsborrow, J. B., & Schoen, R. T. (2019). Brief report: the disability of chronic chikungunya arthritis. Clin Rheumatol, 38(7), 2011-2014.
Amaral, J. K., Bilsborrow, J. B., & Schoen, R. T. (2020). Chronic Chikungunya Arthritis and Rheumatoid Arthritis: What They Have in Common. Am J Med, 133(3).
Arroyo, M. A., & Vilá, M. L. (2015). Rheumatic manifestations in patients with chikungunya infection. PRHSJ, 34(2), 71- 77.
Benjamanukul, S., Osiri, M., Chansaenroj, J., Chirathaworn, C., & Poovorawan Y. (2021). Rheumatic manifestations of Chikungunya virus infection: Prevalence, patterns, and enthesitis. PLoS One, 16(4), 1-15.
Brasil. (2015). Ministério da Saúde. Febre chikungunya: manejo clínico. 1ª edição. Brasília: Ministério da Saúde. http://bvsms.saude.gov.br/bvs/publicacoes/febre_chikungunya_manejo_clinico.pdf.
Brasil. (2017). Ministério da Saúde. Boletim Epidemiológico: Monitoramento dos casos de dengue, febre de chikungunya e febre pelo vírus Zika até a Semana Epidemiológica, (48)3, 1-11.
Brasil. (2020). Ministério da Saúde. Boletim Epidemiológico 51. Monitoramento dos casos de arboviroses urbanas transmitidas pelo Aedes Aegypti (dengue, chikungunya e zika), semanas epidemiológicas 1 a 50, 2020. 51(51), 1-33.
Brito, C. A. A., Sohsten, A. K. A. V., Leitão, C. C. S., Brito, R. C. C. M., Valadares, L. D. A., & Fonte, C. A. M. (2016). Pharmacologic management of pain in patients with Chikungunya: a guideline. Rev Soc Bras Med Trop, 49(6), 668-679.
Cunha, R. V., & Trinta, K. S. (2017). Chikungunya virus: clinical aspects and treatment - A Review. Mem. Inst. Oswaldo Cruz, 112(8), 523-531.
Donalisio, M. R., Freitas, A. R. R. (2015). Chikungunya in Brazil: an emerging challenge. Rev Bras Epidemiol, 18(1), 283-285.
Essackjee, K., Goorah, S., Ramchurn, S. K., & Cheeneebash, J. (2013). Prevalence of and risk factors for chronic arthralgia and rheumatoid-like polyarthritis more than 2 years after infection with chikungunya virus. Postgrad Med J, 89(2), 440-447.
Hibl, B. M., Dailey, N. J. M., Kneubehl, A. R., Vogt, M. B., & Spencer, J. L. (2021). Mosquito-bite infection of humanized mice with chikungunya virus produces systemic disease with long-term effects. PLoS Negl Trop Dis, 15(6), 1-35.
Hua, C., & Combe, B. (2017). Chikungunya Virus-Associated Disease. Current Rheumatology Reports, 19(69), 1-7.
Huits, R., Kort, J., Van, D. R., Chong, L., & Tsoumanis, A. (2018). Chikungunya virus infection in Aruba: Diagnosis, clinical features and predictors of post-chikungunya chronic polyarthralgia. Plos One, 13(4), 1-21.
Javelle, E., Ribera, A., Degasne, I., & Gaüzère, B. A. (2015). Specific management of post-chikungunya rheumatic disorders: a retrospective study of 159 cases in Reunion Island from 2006-2012. PLOS Negl Trop Dis, 9(3), 1-18.
Marques, C. D. L., Duarte, A. L. B. P., & Ranzolin, A. (2017). Recommendations of the Brazilian Society of Rheumatology for the diagnosis and treatment of chikungunya fever. Part 2 - Treatment. Rev Bras Reumatol, 57(2), 438-451.
Neves, E. L. A., & Nunes, P. S. (2018). Carpal tunnel syndrome observed after an arbovirus infection: A preliminary case series report. NeurologicalSci, 12(2), 31-33.
Nisar, M. K., Packianathan, C. (2017). Chikungunya and bilateral sacroiliitis – is there a link? Eur J Rheumatol, 4(1), 81-82.
Oliveira, A. S., & Silva, J. G. (2017). Effect of a physiotherapy program in patient with persistente polyarthralgia after chikungunya fever. Case report. Rev Dor, 18(4), 370-3.
Page, P. (2012). Current concepts in muscle stretching for exercise and rehabilitation. Int J Sports Phys Ther, 7(2), 109-119.
Runowska, M., Majewski, D., Niklas, K., & Puszczewicz, M. (2018). Chikungunya virus: a rheumatologist's perspective. Clinical and Experimental Rheumatology, 36(3), 494-501.
Silva, N. M., et al. (2018). Vigilância de chikungunya no Brasil: desafios no contexto da Saúde Pública. Epidemiol. Serv. Saúde, 27(3), 1-19.
Simon, F., Javelle, E., Cabie, A., Bouquillard, E., & Troisgros. (2015). French guidelines for the management of Chikungunya (acute and persistent presentations). Med Mal Infect, 45(2), 243-263.
Vairo, F., Haider, N., Kock, R., & Ntoumi, F. (2019). Chikungunya: Epidemiology, Pathogenesis, Clinical Features, Management, and Prevention. Infect Dis Clin North Am, 33(4), 1003-1025.
Vu, D. M., Jungkind, D., & Labeaud, A.D. (2017). Chikungunya Virus. Clin Lab Med, 37(2), 371–382.
Weaver, C. S., & Lecuit, M. (2015). Chikungunya Virus and the Global Spread of a Mosquito-Borne Disease. NEJM, 372(13), 1231-1239.
Zaid, A., Gérardin, P., Taylor, A., Mostafavi, H., Malvy, D., & Mahalingam S. (2018). Chikungunya Arthritis: Implications of Acute and Chronic Inflammation Mechanisms on Disease Management. Arthritis Rheumatol, 70(4), 484-495.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2022 Alejandra Debbo; Vinícius Fernando Alves Carvalho; Ângela Maria da Silva; Roque de Almeida Pacheco; José Rodrigo Santos Silva; Weber de Santana Teles; Ruth Cristini Torres; Ângela Maria Melo Sá Barros; Max Cruz da Silva; Maria Hozana Santos Silva
This work is licensed under a Creative Commons Attribution 4.0 International License.
Authors who publish with this journal agree to the following terms:
1) Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
2) Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
3) Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work.
